Venezuela Official visa Application Please enter your contact information Name: Email: Tel: Mobile: The latest date you need your passport returned in time for your travel: Venezuela official visa checklist Filled out and signed Venezuela official visa application form. The form is enclosed. Original, SIGNED Official United States passport with at least 6 months of remaining validity. 2 Photographs. Standard passport photographs 2x2 inches on a white background. Payment. Credit Card Authorization form, Certified Check, or Money Order payable to VisaHQ.com. Return mailer. Prepaid self-addressed return label or payment for FedEx. If you wish to prepay return shipping, please add the shipping fee to the total and provide return address: FedEx 2nd day delivery - add $15 FedEx Standard Overnight - add $20 FedEx Priority Overnight - add $25 FedEx Saturday delivery - add $45 FedEx First Overnight - add $65 Prepaid self addressed mailer - $0 Local pick up in Boston - $0 Name: Company: Address: City: State: Zip:
Venezuela official visa fees for citizens of United States Type of visa Max. validity Embassy fee Our fee Processing time Total Diplomatic up to 90 days $0.00 $59.00 4 business days $59.00 This order is subject to Terms of Service, posted on VisaHQ website. All fees and requirements may change without notice.
Credit Card Authorization Form By signing this form i accept VisaHQ.com Terms of Service and authorize to charge my credit card for the amount of $ Name on the Credit Card: Credit Card number: - - - Exp. date: / Credit Card Billing Address: Signature: Comments: Thank you! We accept all major credit cards.
EMBAJADA DE LA REPUBLICA BOLIVARIANA DE VENEZUELA EN EE.UU SECCION CONSULAR Horario de atención al público: días hábiles de 9:00 am 1:00 pm. SOLICITUD DE VISA VISA APPLICATION FORM 2 fotos 2 photos 1.- DATOS PERSONALES / PERSONAL INFORMATION APELLIDO: LAST NAME: LUGAR DE NACIMIENTO: PLACE OF BIRTH : NOMBRE: FIRST NAME: FECHA DE NACIMIENTO: DATE OF BIRTH: NACIONALIDAD: NATIONALITY SEXO: M ( ) GENDER: F ( ) ESTADO CIVIL: MARITAL STATUS: CASADO ( ) MARRIED SOLTERO ( ) SINGLE DIVORCIADO ( ) DIVORCED VIUDO ( ) WIDOWED OTRO ( ) OTHER DIRECCION COMPLETA DE HABITACION HOME ADDRESS (Include number, street, city, state or province, postal zone and country) TELEFONO TELEPHONE: CORREO ELECTRONICO E-MAIL ADDRESS PROFESION U OCUPACION PROFESSION OR OCCUPATION: NOMBRE DE SU ACTUAL EMPLEADOR NAME OF PRESENT EMPLOYER DIRECCION DE SU EMPLEO ACTUAL ADDRESS OF PRESENT EMPLOYER: NUMERO TELEF. DE OFICINA BUSSINESS PHONE NUMBER NOMBRE, DIRECCION Y TELEFONO QUE DESEE SUMINISTRAR EN CASO DE EMERGENCIA NAME, ADDRESS AND PHONE YOU WISH TO GIVE IN CASE OF EMERGENCY 2.- DATOS DEL PASAPORTE / PASSPORT INFORMATION No. PASAPORTE PASSPORT NUMBER: LUGAR DE EMISION PLACE OF ISSUANCE CIUDAD CITY PAIS COUNTRY TIPO DE PASAPORTE TYPE OF PASSPORT: * ORDINARIO / REGULAR ( ) * DIPLOMATICO / DIPLOMATIC ( ) * OFICIAL / OFFICIAL ( ) * ORGANIZACION INTERNACIONAL/ INTERNATIONAL ORGANIZATION ( ) FECHA DE EMISION DATE OF ISSUE: FECHA DE VENCIMIENTO DATE OF EXPIRATION: 1099 30 th St. NW Washington DC 20007. Tel. (202) 342.22.14. Fax. (202) 342.68.27. www.embavenez-us.org Rev. Enero 2006 1
3.- DATOS SOBRE EL VIAJE / TRAVEL INFORMATION TIPO DE VISA REQUERIDA: ( ) Turista ( ) Negocios ( ) Tránsito ( ) Oficial ( ) Diplomática ( ) Cortesía ( ) Otra TYPE OF VISA REQUESTED: Tourism Business Transit Official Diplomatic Courtesy Other MOTIVO DE SU VIAJE (especifique) WHAT IS THE PURPOSE OF YOUR TRIP? (be specific) TIEMPO DE PERMANENCIA EN VENEZUELA HOW LONG WILL YOU STAY IN VENEZUELA? QUIEN ES RESPONSABLE ECONOMICAMENTE POR SU VIAJE? WHO IS RESPONSIBLE FOR YOUR TRIP EXPENSES? NOMBRE Y DIRECCION DE LA PERSONA/EMPRESA A CONTACTAR EN VENEZUELA NAME & ADDRESS OF THE PERSON/COMPANY TO BE CONTACTED IN VENEZUELA: LUGAR DE ALOJAMIENTO EN VENEZUELA. ESPECIFIQUE NOMBRE Y DIRECCION NAME & ADDRESS OF WHERE YOU WILL BE STAYING IN VENEZUELA : LINEA AEREA Y NUMERO DE VUELO AIRLINE & FLIGHT NUMBER: FECHA DE ENTRADA ARRIVAL DATE: FECHA DE SALIDA DEPARTURE DATE: 4.- INFORMACIÓN ADICIONAL / ADDITIONAL INFORMATION HA VISITADO VENEZUELA ALGUNA VEZ? NO ( ) SI ( ) HAVE YOU EVER BEEN IN VENEZUELA? NO ( ) YES ( ) QUÉ PAISES HA VISITADO USTED EN LOS ULTIMOS DOS AÑOS? WHAT COUNTRIES HAVE YOU VISITED IN THE LAST TWO YEARS? CUANDO?(Más reciente) 1 WHEN? 2 POR CUANTO TIEMPO? 1 FOR HOW LONG? 2 FECHA / DATE: FIRMA SOLICITANTE / APPLICANT S SIGNATURE 1099 30 th St. NW Washington DC 20007. Tel. (202) 342.22.14. Fax. (202) 342.68.27. www.embavenez-us.org Rev. Enero 2006 2